Acadia Re-Opening Plan

Services

Acadia Rehab

Acadia Reopening Implementation Plan
July 15, 2020

Acadia maintains and operates licensed personal care homes with 3 to 8 residents per household providing care to a total of 34 residents. We operate a day treatment clinic where therapies and structured day group activities are offered to residents in our personal care homes and to others in the community. Currently, our day treatment clinic is closed and our residences remain on quarantine. Clinical services are delivered to our residents in their residences. No in-person visitation is permitted between residences or from members of the outside community, including family, friends, and non-essential healthcare personnel or contractors. Acadia does not utilize the services of any volunteers or interns.

Acadia intends to reopen the day treatment clinic in a modified capacity and ease restrictions on community access for residents living in our personal care homes on or after August 10, 2020. Services offered in our day treatment program, including structured day groups and individual therapies, will initially be offered to our residents only, on a part-time schedule of alternating days with staggered arrival and departure times, to keep the number of residents in groups to the required maximums. At present, a plan has not been developed to re-open the day treatment program to non-residents living in the larger community. If at any time Lancaster County returns to the Yellow phase, our residents will return to quarantine within their residences, with visitation restrictions once again in place. If at any time Lancaster County returns to the Red phase of reopening, the day treatment clinic will close.

The development of the plan described below permits Acadia to enter Step 1 of the reopening process, per the PA Department of Health's guidance for all long-term care facilities in the state (see Interim Guidance for Personal Care Homes). This plan will be published on our website or shared with staff, residents, their families or support persons via email or letter. The plan has been sent to the Ombudsman of the Office of Aging and to the PA Department of Human Services (DHS), which has approved it.

Baseline testing for COVID-19

Acadia's plan to implement the order of the PA Department of Health (DOH) directing testing at all long-term care facilities requires baseline testing of all staff and all residents by July 26, 2020. A communication was sent to all staff on July 7, 2020, alerting them to the need to be tested for the COVID-19 virus. Information on where they can get free testing without a doctor's prescription has been provided, with requirement to schedule the appointment at one of several local testing sites as soon as possible and no later than July 26. They were instructed to send a copy of their test result to Acadia's Director of Human Resources, who will ensure the information is entered on the tracking form provided by the state, and who will submit the form to the state once testing is complete. After this communication was sent, Acadia had opportunity to order COVID-19 virus test kits from DOH for all residents and staff. We will have our LPN and other designated, qualified staff administer the tests to all staff and all residents who have not been tested since June 12, 2020 with a negative test result. Other testing procurement methods will remain available as alternative options through the deadline established.

A communication was sent to families or support persons of our residents via email or letter on July 10, 2020 explaining the state's requirement for universal baseline testing and our plan for its accomplishment. A communication was sent to our residents via email to staff at their residences, with request that the information be shared with each resident before the end of the day on Monday July 13, 2020.

Once we have completed baseline testing for all of our staff and residents, and have the absence of any new facility onset of COVID-19 cases (resident or staff) for 14 consecutive days since the completion of baseline testing, we will enter Step 2 of the reopening process.

If baseline testing reveals a positive finding for COVID-19 in an asymptomatic resident of Acadia, we will isolate the resident in their bedroom or relocate the resident to a furnished apartment within the Bentley Ridge community dedicated to housing residents with potential exposure to COVID-19, providing all care there for at least 14 days and until they have been symptom-free for at least 72 hours.

If baseline testing reveals a positive finding for COVID-19 in an asymptomatic staff person, the staff person will be excluded from work and required to isolate for 10 days from the date of their first positive test, if they have not developed symptoms. The staff will meet PAHAN 501 criteria for return to work.

Refusal of testing

If a resident refuses to be baseline tested, Acadia will attempt to isolate the resident in their bedroom, providing all care and all meals there for at least 14 days after refusal. If the resident will not comply with the isolation request, they will be moved to a COVID-potentially exposed residence until at least 14 days after refusal, per PA-HAN-509. If the resident develops symptoms consistent with COVID-19, the testing request will be re-visited with the resident and/or the resident's family or support person, in an effort to gain compliance.

Acadia requires all staff to be baseline-tested for COVID-19, and new testing will be required if they display signs or symptoms of the virus in the future. If a staff person refuses testing, they will be removed from the schedule and unable to provide direct care of our unexposed residents. This is done to reduce the risk of exposure to our vulnerable population of residents, to fellow co-workers and to reduce the risk of community spread.

Testing for a resident or staff person showing symptoms of COVID-19

If a resident shows symptoms of COVID-19,


If a staff person shows symptoms of COVID-19,

Cohorting residents with COVID-19

Our plan to cohort or isolate non-hospitalized residents of our program is in keeping with PAHAN 496 and includes:

Infection Control and PPE

Staff implements infection control practices that are in compliance with PAHAN 497. Staff clean and sanitize the environment in keeping with our own policies and procedures and in keeping with CDC guidelines on Cleaning and Disinfecting for Community Facilities. All of Acadia's staff have received standard, video-based training in correct use of PPE, and those staff who have volunteered to provide direct care to any COVID-19 positive residents have had in-person training from our occupational therapist. Any staff who is assigned to provide care to a COVID-19 positive resident will also receive in-person training from our occupational therapist. Acadia continues to procure and maintain an adequate supply of PPE for our staff based on the type of care we expect to provide. Each residence has a "biohazard box" that contains PPE and related supplies, which is inventoried each week and restocked as needed. Staff members working within a residence wear face masks and implement universal precautions at all times, per PAHAN 492. All staff persons are required to be masked at all times, and residents are strongly encouraged and supported in efforts to stay masked when in common areas of their residence.

Staffing Patterns

Acadia is currently operating with normal staffing patterns. If we begin to experience a staffing shortage due to COVID-19, we will implement a contingency staffing plan that re-appropriates staff to meet the current need. This would include the use of case managers, cognitive rehabilitation therapists, supervisors and members of the executive leadership team as able and qualified to provide for the direct care needs of our residents. Our contingency plan includes mandatory overtime if the need for caregivers cannot be otherwise met.

Staff persons who have suspected or confirmed COVID-19 must meet the requirements of PAHAN 501 before they can return to work at Acadia. Staff members who have had signs or symptoms of other illnesses, but who are not suspected of having COVID-19, and if tested have a COVID-19 negative finding, must meet the CDC criteria for return to work for healthcare personnel which states that at least 3 days (72 hours) have passed since recovery (defined as resolution of signs and symptoms of illness and resolution of fever without the use of fever-reducing medications) and no fewer than 7 days have passed since the onset of signs or symptoms of illness or fever.

Staff Logs

Acadia has implemented a screening protocol for all staff persons, which requires them to take and record their temperature at the time they enter any of Acadia's facilities, to indicate whether they have any signs or symptoms of illness, if they have had any known exposure to a person with COVID-19 or suspected to have COVID-19 in the 14 previous days, and to verify that they have washed their hands with soap and water for at least 20 seconds immediately before beginning their work at Acadia.

Staff persons must also take and record their temperature at the end of their shift, and are asked to record if they have any signs or symptoms of illness at that time. Staff who have fever over 99.4 degrees F. or who have signs or symptoms of illness may not work. Staff logs are reviewed daily by designated supervisors and kept on file in case there is need to perform contact tracing.

Resident Logs

Staff persons take and record each resident's temperature twice daily, and a pulse-ox reading once daily. They assess each resident for signs or symptoms of illness daily. This information is maintained on the residential house logs so that all staff persons have access to the information as needed. Personal Care Home Administrators review the log for their residences daily. If a resident has a fever over 99.4 degrees F. or has signs or symptoms of illness, they will be isolated within their bedroom and their PCP will be notified for guidance.

Dining Services

Residents within each of our residential facilities dine in a common area within their residence, with staggered meal times to enable maximum social distancing while eating. Residents may choose to eat meals in their bedrooms or in the living room on foldable trays if that is their preference. If a resident is at high risk for choking, assisting staff persons will wear eye protection and gowns during feeding. Staff persons who assist more than one resident at a time during meals use hand sanitizer each time when switching assistance between residents. All hard surfaces are sanitized before and after a resident dines.

Structured Activities

Structured group activities are currently offered daily within each of our quarantined residences for the members of that household only, with no more than 5 residents in a room together. Masks are worn by staff and residents at all times, social distancing is practiced, and hand hygiene is maintained with use of hand sanitizer and/or soap and water. At Step 1 of our reopening, group size will continue to be limited to 5 residents of a single residence within a room. Because some of our residences house 6 to 8 residents, group activities in which more than 5 residents of a household wish to participate are conducted across 2 rooms of the residence, to ensure social distancing. At Step 2 of our reopening, group activities will be conducted with no more than 10 residents, and may be conducted within our day treatment clinic facility with residents from Acadia's other residences, ensuring that social distancing is maintained. Once we enter Step 3 of reopening, we will conduct structured activity groups at our day treatment clinic with all unexposed residents, using enough rooms within the facility to ensure that social distancing is maintained.

Visitation Plan

Currently, only virtual or between-glass visits are permitted between residents and family members or friends. Personnel from medical facilities and the Department of Human Services (or its designees working on behalf of the department) may enter the residences. The Department of Aging/Area Agency on Aging, including the Ombudsman, are permitted to visit under certain circumstances (see section 4 of Interim Guidance for Personal Care Homes).

Acadia will allow limited in-person visitations for non-COVID-19 exposed residents beginning no earlier than August 10, 2020, when we anticipate that we will enter Step 2 (14 days after the completion of baseline testing and meeting all state prerequisites for reopening). Visitation at Step 2 will be permitted in outdoor designated areas only. Visitation at Step 3 will include indoor visits in designated areas, although outdoor visitations will be encouraged. Visitors must wear face masks, use hand sanitizer and/or soap and water to maintain hand hygiene, and practice social distancing for the entire visit as indicated by marked spaces.

All visitors and non-essential personnel entering an Acadia facility will be required to complete a log similar to that used by staff every time they visit. The log will require a record of temperature and affirmation that hand hygiene has been performed upon arrival at the facility, as well as affirmation that they are not currently experiencing any signs or symptoms of COVID-19, and have not knowingly been exposed to anyone with suspected or confirmed COVID-19 in the past 14 days. Visitors must provide contact information in case contact tracing becomes necessary. Visitors will also be expected to sign out when they leave. Visitation from residents of other Acadia residences or other long-term care facilities will only be permitted if there is no new facility-onset of COVID-19 in the visitor's residence.

Acadia will permit in-person visitation at our residential facilities at Step 2 through Step 3 of our reopening. Visits may be scheduled during the following hours:

Visits must be pre-arranged with the resident's case manager; unscheduled visits will not be permitted. Children are permitted to visit as long as they are accompanied by an adult visitor, managed appropriately by the adult visitor, and able to maintain 6-feet of social distance during the entire visit. Only residents with no fever or signs or symptoms of illness will be permitted to have visitors at Acadia. Only 2 people may visit a resident at the same time, and there will be no occurrences of multiple (2 or more) residents having visitors at the same time.

Visits may not last more than 60 minutes, so that we can try to ensure all who wish to visit on a given day have that opportunity. Consideration will be given for extenuating circumstances and special occasions. All visits will occur outdoors, with clearly marked 6-foot distances between visitors and residents. Acadia will ensure that there is either natural coverage or a canopy erected to protect visitors from the sun. Seating will be made available, as well as hand sanitizer and disinfecting agents.

After entering Step 3, Indoor visits will be permitted when weather or the heat index prevents comfortable outdoor visits. Indoor visits, when permitted, will occur in the dining area only, where enough space exists to permit social distancing. Visitors, including children, must stay in the designated visiting area. Visits may not occur in a resident's bedroom unless they are unable to be transported to the designated area, per state requirement. Visitors will not have access to a restroom within the residence during the visit. A list of nearby public restrooms will be provided upon request.

Visitors are expected to bring a facemask to wear while visiting. It must cover their nose and mouth except when briefly removed to drink. Children older than 2 years of age must bring and wear a facemask during the entire visit, except when briefly removed to drink. Residents will be provided a facemask to wear during the visit. Hand sanitizer must be used before the visit and will be provided by Acadia if needed.

When visitors schedule a visitation, they will be provided the phone number of the supervisor or Administrator who will be on call during the visit. Visitors will be expected to call the supervisor to alert them to their arrival. Signage will be posted at the entry station to remind visitors of this requirement. When visitors leave, staff persons will disinfect the visitation area with an EPA-registered disinfectant to ensure sanitization.

Outings

When Acadia enters Step 3 of our reopening, we will begin scheduling community outings for our residents who are unexposed to COVID-19. Outings will be limited to no more than the number of people with which social distancing can be maintained, including in vehicles. When our vans are used to access the community or the day treatment clinic, no more than the driver and 2 residents, therefore, will be permitted in a single van. Our 5 passenger cars will be used to transport no more than 1 resident at a time.

Acadia will publish updated information about our reopening plans as events related to the COVID-19 pandemic warrant.

Acadia's Home and Community Based Services focus on working together with the individual served to enhance their abilities and expand their potential to live, work and function as autonomously and independently as possible. Home and community-based services are person-centered, focusing on the individuals' desires, needs and personal goals. They promote a culture of autonomy, diversity and individual choice, in keeping with the preferences of the individual.

Our services include Outpatient, Day Treatment and Residential programs. For individuals receiving services within our Residential program, we provide a comprehensive Day Treatment Program each weekday that is tailored to meet their unique needs for group activities and individual therapies. For individuals who live in the larger community, we offer individualized outpatient treatment programs daily that include individual therapies and selected therapeutic group activities.

Participants are usually referred to Acadia through a service coordinator, hospital case manager, discharge planner, physician, psychologist, nurse case manager, or other healthcare or human service provider. Referrals also frequently come from family, schools or other state and local community providers. Self-referrals are also taken.

Individuals seeking services at Acadia are carefully assessed to determine whether or not enrollment is appropriate and, if so, what type of services will be most beneficial. Acadia is committed to providing services that are comprehensive in scope and flexible in delivery. These services are designed to meet the specific needs of each participant, and support their right to self-direct their involvement in the rehabilitation process. The emphasis on individualization and continuity of care enables individuals to move through the program at their own pace. The frequency, intensity and duration of programming will vary depending on the needs of the individual and availability of funding. The appropriate continuum of care is identified at the time of referral and continues throughout ACADIA's programming.

Day Treatment Services

Our Day Treatment Program offers a full range of therapeutic services Monday through Friday, 8:30 am – 4:30 pm, in the community as well as in our spacious and well-equipped clinic located in the lovely Greenfield Corporate Center in Lancaster. Therapeutic services capitalize on an individual's strengths to address areas for improvement identified during initial and ongoing evaluations. We provide health and wellness activities, individualized and adaptive counseling to focus on problem-solving in the home and community, the development of social skills, communication skills, self-care skills, stress reduction and relaxation skills, leisure skills, pre-vocational skills and time management skills. We also support the interested individual to find and participate in volunteer work within the community.

Our therapeutic services include:

  • Neuropsychology
  • Cognitive rehabilitation therapy
  • Counseling and behavior management
  • Speech-language therapy
  • Occupational therapy
  • Physical therapy
  • Structured day group therapy activities
  • 1:1 assistance to those individuals who require a more intensive level of support to be able to participate effectively in our structured day activities

schedule an initial screening assessment

Individual cognitive rehabilitation therapy is a part of our Day Treatment Program and focuses on the development and use of compensatory strategies to address cognitive challenges including problems with attention, memory, new learning and problem-solving. Counseling addresses awareness of and adjustment to disability, motivation for rehabilitation, and healthy functioning within interpersonal relationships. It also addresses the need for behavioral change to engage more effectively with others and participate actively within the community. Structured day groups offer opportunities to apply social, cognitive and behavioral skills in a variety of meaningful activities in the clinic and in integrated community settings.

Our cognitive rehabilitation therapists are Bachelor's and Master's level clinicians who have earned the Certified Brain Injury Specialist (CBIS) credential. Our neuro-rehabilitation assistants, who assist our therapists to run group activities in the clinic and community and who provide direct care to all participants, are trained to understand behaviors associated with brain injury, autism and other neurological disorders. They understand and use methods of positive behavior management that lead to better outcomes.

In addition to our therapeutic services, we offer:

  • Internal case management
  • On-site availability of a nurse
  • Regular treatment team consultation with our Medical Director, who is a Behavioral Neurologist/Neuropsychiatrist

Our case management team effectively coordinates services received at Acadia and serves as a liaison to external providers working with the people we serve. They facilitate person-centered, team-based discussions of individuals' progress toward treatment goals and communicate regularly with participants and their family members. Our nurse oversees the administration of medications to our Residential Program participants, assists them to participate in appointments with their physicians, and is available to manage emergent medical issues that arise during the Day Treatment Program.

See our Admission Guidelines

Residential Services

Acadia's Residential Program is provided in beautiful, well-maintained apartments and townhomes just a short distance from our Day Treatment clinic. The residences offer modern, well-equipped and attractive living quarters with private bedrooms for each person. Individuals may decorate their living areas in keeping with their personal preferences and to create a true sense of "home." Between 3 and 8 individuals live in each residence, and enjoy all the benefits of true community integration, enjoying natural social opportunities with neighbors.

The focus of Residential programming is on health and wellness, and the enhancement of daily living skills in the home, including:

  • Daily personal hygiene routines
  • Healthy meal planning and preparation
  • Budgeting and shopping
  • Laundry and other household cleaning tasks
  • Social and recreational activities in home and in community
  • Building and maintaining healthy relationships

Our residential staff are present to provide care 24 hours a day, 7 days a week, including awake overnight staff. They encourage and support participants to exercise their autonomy and independence in making decisions about their daily activities. They understand each participant's unique set of limitations and capabilities and provide assistance in keeping with individual needs. Transportation to the Day Treatment clinic and to all program activities in the community is provided. For individuals who would like to access the community more independently, assistance is provided to learn to use public transportation.

Individuals in our Residential Program have an individually customized schedule of therapies and structured group activities in the Day Treatment Program Monday through Friday. Our nurse manages the emergent medical needs of participants in our Residential Program, coordinating their medical care with physicians and other healthcare providers in the community. They work closely with Acadia's consulting Medical Director, a Behavioral Neurologist/Board-Certified Neuropsychiatrist, to manage the medical contributors to behaviors that can interfere with participation in rehabilitation and community-based activity.

What Are Acadia's Admission Criteria?

  • 18 years of age or older, depending on funding source
  • Diagnosis of a post-acute brain injury or neuropsychological/neurodevelopmental disorder that affects physical, cognitive, behavioral, social and/or vocational functioning
  • Medical stability, without requirement of on-going skilled nursing care
  • Psychiatric stability
  • Absence of significantly maladaptive or disruptive behavior that would interfere with program participation or that could be disruptive to the care of others receiving services
  • Willingness to abstain from the use of alcohol, recreational drugs and illegal substances while receiving services
  • Willingness to participate and ability to benefit from community-integrated programming
  • Absence of current risk of elopement

Home and Community Services

Acadia is an accredited provider of home and community-based services for adults. Home and community-based services are person-centered, focusing on the individuals' desires, needs and personal goals. They promote a culture of autonomy, diversity and individual choice, in keeping with the preferences of the individual. Acadia embraces the unique variety of cultures among our staff and the people we serve. The principles of diversity and inclusion are important values that positively influence the way we provide care so that all feel welcomed, included and respected. Unique communication and behavioral needs are addressed through a transdisciplinary, team-based model of intervention. Acadia's clinical team is knowledgeable of available resources that may benefit the individual, including technology.

As a provider of home and community services, we work to enhance the individual's quality of life by helping them to participate effectively and meaningfully in a variety of everyday pursuits within the community. We help the individual learn to function adaptively and perform successfully in whatever environments those activities occur. We can help participants who need assistance in connecting with family, friends or others within their homes and communities.

Structured day group activities focus on the application of social skills and problem-solving skills in everyday environments. They are delivered in a variety of community venues, including shopping malls, grocery stores, movie theaters, sports arenas, parks and recreation centers, and so on. One-to-one assistance for behavioral support or physical needs may be arranged to enhance effective participation in structured day groups and residential programming activities.

When an individual enters Acadia's Residential Program, the residence becomes their home, and services are delivered there and in our Day Treatment Program. For those who do not receive residential services but live in a private home in the larger community, structured day services and individual therapies can be delivered in our Day Treatment Program or other community locations, including workplaces, volunteer locations and schools. There may be opportunities for tele-rehab or video-conferencing service delivery and for in-person individual therapy sessions in the home.

Collaboration with Families and Family Services

The rehabilitation journey can be complicated, and collaboration with the families (and significant others) of the individuals we serve promotes the best outcomes. Acadia's leadership and staff understand the importance of listening to and learning from those who are close to the individuals we serve. If a participant so chooses, their family and significant others are included in the treatment team from the start, providing input for goal development and assistance is assessing progress. They bring valuable experience and insight about the participant's habits and routines, preferences, interpersonal abilities and communication styles to treatment planning and intervention. Treatment is most effective, and gains are most durable, when families and significant others work with our clinical and residential staff to promote the participant's growth, skill development and functional independence. A collaborative approach to treatment might include the development of behavior support plans to support positive interactions at home and in the community. In keeping with the participant's desire to share information, families and significant others receive progress reports at team meetings and have ready access to the participant's case manager whenever there are concerns or ideas to share. They are welcome visitors at our residential facilities; visits during day treatment hours can also be arranged.

Acadia understands that families and significant others are presented with unique challenges in adapting to the changes that brain injury or other neurological conditions can bring to family life. Throughout the duration of care, Acadia works to help by providing information and education to families to help them anticipate, identify, accept and manage these challenges. Designated clinical staff can be scheduled to meet with individual family members and significant others to address adjustment issues as they arise.

For those whose loved one is living with a brain injury, we extend an invitation to attend and participate in our Brain Injury Support Group, offered on the first Thursday evening of each month in our clinic facility. In addition to providing emotional support, Acadia works to connect families and significant others to resources within the community to address the medical, financial, and social implications of brain injury and other neurological conditions.

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